Medical education and the quality improvement spiral: a case study from Mpumalanga, South Africa

Background: The short timeframe of medical students' rotations is not always conducive to successful; in-depth quality-improvement projects requiring a more longitudinal approach.Aim: To describe the process of inducting students into a longitudinal quality-improvement project; using the topic of the Mother- and Baby-Friendly Initiative as a case study; and to explore the possible contribution of a quality-improvement project to the development of student competencies.Setting: Mpumalanga clinical learning centres; where University of Pretoria medical students did their district health rotations.Method: Consecutive student groups had to engage with a hospital's compliance with specific steps of the Ten Steps to Successful Breastfeeding that form the standards for the Mother- and Baby-Friendly Initiative. Primary data sources included an on-site PowerPoint group presentation (n = 42); a written group report (n = 42) and notes of individual interviews in an end-of-rotation objectively structured clinical examination station (n = 139). Results: Activities in each rotation varied according to the needs identified through the application of the quality-improvement cycle in consultation with the local health team. The development of student competencies is described according to the roles of a medical expert in the CanMEDS framework: collaborator; health advocate; scholar; communicator; manager and professional. The exposure to the real-life situation in South African public hospitals had a great influence on many students; who also acted as catalysts for transforming practice.Conclusion: Service learning and quality-improvement projects can be successfully integrated in one rotation and can contribute to the development of the different roles of a medical expert. More studies could provide insight into the potential of this approach in transforming institutions and student learning

Undergraduate emergency medicine in an african medical school : experiences from Botswana

Introduction: In August 2011; the first cohort of students at the University of Botswana School of Medicine (UBSOM) began their third year of undergraduate medical training. As part of their 2011-2012 curriculum they each completed a 10 week rotation in Emergency Medicine (EM); involving problem based learning (PBL) sessions; maintenance of log books; case presentations; and clinical time at the Emergency Centre (EC) of the main tertiary referral hospital in Gaborone; Princess Marina Hospital. Methods :Since EM rotations are often undertaken in the final year of medical training; students were given an anonymous voluntary survey to study the effect of an EM experience in their first clinical year of training. A 5-point Likert scale was used to evaluate learning opportunities and the overall EM experience. Students described which procedures they had observed or performed in their rotation. The survey concluded with open-ended questions seeking additional feedback. Results : These were very encouraging for both early exposure to EM and the PBL approach. More than 90 of students agreed or strongly agreed that they felt more confident in clinical settings; improved their clinical decision making process; and found the PBL model to be effective over the rotation. 22 different procedures were observed in the EC with 100 observing venesection and plaster applications. 14 different procedures were performed with 83 students performing venesection and over 65 performing chest compressions and venous cannulation. Discussion : It is hoped that this study will provide valuable practical information about undergraduate EM learning in a PBL based Medical School within Sub Saharan Africa that can be replicated across other medical education institutions throughout the region

Residents' Perception of Postgraduate Radiology Training in Nigeria

BACKGROUND: Literature on radiology residency in Nigeria is sparse; even for decades after its commencement. There is therefore the need to inquire into the problems and prospects of the programme; at least from the perspectives of the residents. OBJECTIVE: To determine residents' perception of the radiology residency programme; residents' view on state of facilities; and their opinion on the future of radiology training in Nigeria. METHODS: Self-administered semi-structured questionnaires; were given to residents to complete. Contacts were made with residents during update courses and radiologists' conferences or meetings. RESULTS: One hundred and twenty-five questionnaires were given out and 120 were completed and returned; giving a response rate of 96. Fifty-eight (48) respondents mentioned academic interest as the major influencing factor for enrolling into the programme. Only 20 (16) residents had made up their minds to do radiology residency as medical students. All the residents identified conventional radiography and ultrasound as the only regularly functioning modalities in their centres; while 72 (60) respondents mentioned same for cross sectional imaging modalities; that is CT and MRI. One hundred and ten (90) respondents had rotation through available modalities as the plank of their training programmes; and 96 (80) did not feel happy about the state of teaching aids at their centres. Ninety-six (80) of the residents expressed satisfaction at the efforts of the supervisory postgraduate medical colleges at organising update courses. Eighty respondents (65) mentioned limited (or lack of) exposure to modern imaging modalities as the greatest threat to the future of radiology residency in Nigeria. CONCLUSION: Nigerian radiology residents are concerned about lack of modern imaging tools; facilities at their centres; as well as opportunities for exposure overseas; and the likely impact of these on their training and the future of the specialty in Nigeria